沙美特罗替卡松联合异丙托溴铵治疗老年急性加重期慢性阻塞性肺疾病患者的疗效观察

Efficacy of salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of COPD

目的探讨沙美特罗替卡松联合异丙托溴铵治疗老年急性加重期慢性阻塞性肺疾病(COPD)患者的疗效。方法本研究为随机对照试验。选择2020年3月至2022年3月连云港市第二人民医院收治的老年急性加重期COPD患者126例,随机数字表法分为两组,各63例。对照组男34例、女29例,年龄(69.19±4.25)岁,给予异丙托溴铵治疗;观察组男32例、女31例,年龄(69.04±4.36)岁,在此基础上联合沙美特罗替卡松治疗,两组均治疗14 d。对比两组临床疗效,治疗前后肺功能、血清炎症因子水平、气道重塑指标、不良反应发生情况。采用t检验、χ^(2)检验。结果观察组治疗总有效率为96.83%(61/63),高于对照组79.37%(50/63),差异有统计学意义(χ^(2)=9.157,P=0.002)。治疗14 d后,观察组第1秒用力呼气量(FEV1)、用力肺活量(FVC)、第1秒用力呼气量占用力肺活量比值(FEV1/FVC)水平分别为(1.94±0.55)L、(2.59±0.54)L、(76.04±8.01)%,均高于对照组[(1.53±0.49)L、(2.23±0.51)L、(67.94±7.35)%],差异均有统计学意义(均P<0.05)。治疗14 d后,观察组肿瘤坏死因子-α(TNF-α)、超敏-C反应蛋白(hs-CRP)、白细胞介素(IL)-6、IL-8水平分别为(54.02±11.05)mg/L、(8.99±1.46)mg/L、(57.15±8.02)ng/L、(34.12±8.38)ng/L,均低于对照组[(68.04±10.84)mg/L、(12.33±2.08)mg/L、(64.70±7.83)ng/L、(40.73±9.09)ng/L],差异均有统计学意义(均P<0.05)。治疗14 d后,观察组基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制剂-1(TIMP-1)、转化生长因子-β(TGF-β)水平分别为(8.39±1.79)mg/L、(56.02±8.79)mg/L、(81.85±11.06)ng/L,均低于对照组[(10.81±2.04)mg/L、(63.91±9.48)mg/L、(95.70±12.25)ng/L],差异均有统计学意义(均P<0.05)。观察组总不良反应发生率与对照组相比,差异无统计学意义(P>0.05)。结论沙美特罗替卡松联合异丙托溴铵治疗老年急性加重期COPD患者可提高疗效,改善肺功能与气道重塑效果,减轻血清炎症因子水平,且不会增加不良反应,安全可靠。

Objective To explore the efficacy of salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease(COPD).Methods It was a randomized controlled trial.A total of 126 elderly patients with acute exacerbation of COPD admitted to Lianyungang Second People's Hospital from March 2020 to March 2022 were selected and were divided into two groups by the random number table,with 63 cases in each group.In the control group,there were 34 males and 29 females,aged(69.19±4.25)years;in the observation group,there were 32 males and 31 females,aged(69.04±4.36)years.The control group was treated with ipratropium bromide,and the observation group was treated with salmeterol ticasone on this basis.Both groups were treated for 14 days.The lung function,serum inflammatory factor levels,and airway remodeling indexes before and after treatment,clinical efficacy,and occurrence of adverse reactions were compared between the two groups.t test andχ^(2) test were used.Results The total effective rate of the observation group was 96.83%(61/63),which was higher than that of the control group[79.37%(50/63)],with a statistically significant difference(χ^(2)=9.157,P=0.002).After 14 days of treatment,the forced expiratory volume in the first second(FEV1),forced vital capacity(FVC),and ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC)in the observation group were(1.94±0.55)L,(2.59±0.54)L,and(76.04±8.01)%,respectively,which were higher than those in the control group[(1.53±0.49)L,(2.23±0.51)L,and(67.94±7.35)%],with statistically significant differences(all P<0.05).After 14 days of treatment,the levels of tumor necrosis factor-α(TNF-α),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),and IL-8 in the observation group were(54.02±11.05)mg/L,(8.99±1.46)mg/L,(57.15±8.02)ng/L,and(34.12±8.38)ng/L,respectively,which were lower than those in the control group[(68.04±10.84)mg/L,(12.33±2.08)mg/L,(64.70±7.83)ng/L,and(40.73±9.09)ng/L],with statistically significant differences(all P<0.05).After 14 days of treatment,the levels of matrix metalloproteinase-9(MMP-9),matrix metalloproteinase inhibitor-1(TIMP-1),and transforming growth factor-β(TGF-β)in the observation group were(8.39±1.79)mg/L,(56.02±8.79)mg/L,and(81.85±11.06)ng/L,respectively,which were lower than those in the control group[(10.81±2.04)mg/L,(63.91±9.48)mg/L,and(95.70±12.25)ng/L],with statistically significant differences(all P<0.05).There was no statistically significant difference in the total incidence of adverse reactions between the observation group and the control group(P>0.05).Conclusion Salmeterol ticasone combined with ipratropium bromide in the treatment of elderly patients with acute exacerbation of COPD can improve the efficacy,improve the lung function and airway remodeling,and reduce the serum inflammatory factor levels,which does not increase the adverse reactions and is safe and reliable.